Opercular syndrome: Case reports and review of literature

Five cases of “bilateral opercular syndrome” of vascular etiology are reported. Cortical pseudobulbar palsy (i.e. spastic anarthria and inability to swallow) with dissociation of automatic voluntary movements in the affected muscles are the essential features of this syndrome. Additional motor and sensory symptoms differentiate its subtypes. All 5 patients had bilateral opercular syndrome. The unusual features was its occurrence as the presenting feature of preeclampsia in a young lady, and the development of the transient syndrome following a right focal seizure with generalization at high altitude in a young female trekker who had an old unilateral infarct in left opercular region. Whereas the limb motor weakness recovered well, the recovery was unsatisfactory for speech and for swallowing.

ACCURACY OF SERUM - ASCITES ALBUMIN GRADIENT IN THE AETIOLOGICAL DIAGNOSIS OF ASCITES.

50 adults with ascites admitted to our hospital were studied. Simultaneous samples of ascitic fluid and blood were collected and subjected to analysis including ascitic fluid total protein and serum ascites albumin gradient The cut off value of serum-ascites albumin gradient for differentiating between high and low gradient was taken as 1.1 gm % and of ascitic fluid protein for differentiating exudate and transudate as 2.5 gm%. The sensitivity, specificity, positive predictive value and negative predictive value of high gradient and transudative ascites in diagnosing portal hypertension were 943%, 60%, 84.6%, 81.8% and 62.9%, 133%, 91.7% and 50% respectively. High gradient ascites is a sensitive test in the diagnosis of portal hypertension as a cause of ascites. The exudate-transudate approach has severe limitations in the differential diagnosis of ascites.

GRANULOCYTE MACROPHAGE COLONY STIMULATING FACTOR IMPROVES IMMUNOGENECITY OF HEPATITIS B VACCINE IN HEMODIALYSIS PATIENTS.

Only 20-50% of hemodialysis patients, develop protective antibodies following double dose Hepatitis B vaccination. Early reports suggest augmented response with concomitant use of Granulocyte macrophage colony stimulating factor (GMCSF). This study was done to assess the response rate to hepatitis B vaccine in hemodialysis patients with use of GMCSF. Seventeen patients were included in study, all received 40 mcg of hepatitis B vaccine at 0,1 and 2 months. Ten of these received 150 mcg of GMCSF with each dose of vaccine while 7 were taken as controls. Only one patient from control group (14.3%) while 5/10 (50%) patients from GMCSF group, developed protective antibodies, i.e. anti HBS titres > 10miu/ml (p < 0.05). Present study shows the beneficial effect of GMCSF when used as adjuvant with hepatitis B vaccine, in hemodialysis patients.